When COVID-19 was declared a pandemic, many nations—including highly resourced ones—found themselves unprepared to deal with the rapidly unfolding public health crisis. Underlying vulnerabilities that had long predated the pandemic—such as health inequalities and flawed communication between public health and healthcare delivery systems—were brought to the fore. Many response plans that had looked good on paper now failed to deliver in practice. The upshot: public health systems were not as resilient to acute threats as had been assumed. Indeed, criticism surrounding the initial response by some national public health authorities to monkeypox1—which the World Health Organization declared a Public Health Emergency of International Concern on July 23, 2022, suggests there is more work to be done.
Many governments are investing in strengthening their pandemic preparedness. But how will they know if those investments will prove effective when the next crisis strikes? To help leaders gauge and track their state of readiness, identify opportunities for improvement, and ensure adequate funding continues to flow toward these efforts, McKinsey designed a Pandemic Preparedness Survey. In addition, this article outlines four action areas to help leaders contextualize survey findings, as well as broader lessons from the COVID-19 pandemic, to ensure that public health systems are ready for whatever crises the future brings.
Elements of preparedness
As COVID-19 demonstrated, pandemics touch all of society. Therefore, mounting an effective response calls for specialized capabilities and enablers within and beyond public health systems. Participants in the Geneva Preparedness Forum 2022: Measuring Pandemic Preparedness, held on the sidelines of the World Health Assembly in May 2022, noted the importance of a holistic response involving every part of government to counter pandemics.
McKinsey’s Pandemic Preparedness Survey encompasses five capabilities for managing infectious outbreaks: epidemic prevention; threat identification and surveillance; emergency preparedness and response operations; emergency manufacturing, procurement, and supply chain management; and access to innovation. These capabilities are underpinned by a set of enablers that are designed to deliver across many areas of government, but that have aspects specific to pandemic preparedness: technology and data, public communications, finance, talent, organizational design, and partnerships (exhibit). Finally, successful pandemic preparedness is more likely to occur in a high-functioning wider health system and emergency management landscape.
Not only can this framework serve as the basis for a potential checklist for leaders but the insights it delivers also can help demonstrate where funding is proving effective and where resources may need to be redirected.
Global leaders are embracing efforts to strengthen pandemic preparedness (see sidebar, “Investing in pandemic preparedness and response—selected examples”). Beyond crisis response, these investments can help advance wider public health system goals, bridging the gap between verticals like preparedness and the broader health system’s strengthening agenda.2 But the drive to mount new public health funding may not necessarily last. Political and public attention spans can be short, and COVID-19 has already slipped down the priority list in many countries.3 Efforts to communicate the benefits of continuing to invest in the future could suffer from the classic “prevention curse”—when the system is working well and there’s no crisis afoot, stakeholders may question whether ongoing spending is really needed.
To maintain momentum, public health leaders may need to demonstrate that new funding is creating measurable improvements in pandemic preparedness, and current tools may not be fully suited to this objective. While some tools developed before the COVID-19 pandemic have made important contributions, they have not always been correlated with outcomes.4 Others, like the Joint External Evaluation process, provide a detailed, public-facing assessment but are conducted relatively infrequently.5 And while publicly accountable mechanisms, such as WHO’s Universal Health and Preparedness Review, could be critical to ensuring public trust, they may not be targeted or frequent enough to suit the needs of some jurisdictions.
The Pandemic Preparedness Survey is designed to provide public health leaders with an immediate snapshot of their current preparedness, helping them direct investments to the areas of greatest need. They can also retake the survey to track progress over time, as programs are executed and resources deployed to help further target and adjust investments, as well as communicate the value of them.
Four steps for improving preparedness
Pandemic preparedness is likely to be more successful if the wider public health system and emergency management landscape is high functioning. We’ve identified four areas where governments can focus their efforts to help improve readiness. Each of these areas has suffered historically from underinvestment, and those vulnerabilities were laid bare by the COVID-19 pandemic.
- Ensure access to innovation. Biomedical innovation has saved millions of lives during the COVID-19 crisis,6 but ensuring full and equitable access to its fruits has remained a persistent challenge.7 This was seen most acutely with COVID-19 vaccines, where high-income countries had earlier and more widespread access than most lower-income countries. Monkeypox vaccine distribution has faced similar challenges.8 And solving those challenges is an issue both of capacity and allocation. As we discussed in our article “Not the last pandemic: Investing now to reimagine public-health systems,” which estimated financing needs in this space, future preparedness will almost surely require increasing global capacity for manufacturing of vaccines and other countermeasures.9 Agreements are needed, among and within countries, for who will benefit first from that capacity when it is needed. Countries can work backward from a performance standard. For example, they might want to ensure that high-risk populations can access a new vaccine within three months of licensure and all citizens can access it within six months. Achieving this might require a combination of building local manufacturing capacity and establishing agreements with manufacturers in other locations.
- Invest in public health data systems and IT. During the early stages of the COVID-19 pandemic, many countries learned firsthand how years of underinvestment in public health data, analytics, and technology could slow effective crisis response.10 Integration of public health and care delivery system data to understand bed capacity was a particular pain point during COVID-19, requiring ad hoc workarounds for some nations.11 Reporting of monkeypox cases also continues to vary across jurisdictions.12 Minimal IT infrastructure existed in many places to facilitate targeted communication to particular population segments. And disease surveillance systems often relied on time-intensive processes to integrate different types of data. Countries including the United States are investing to address these gaps.13 New funding could build lasting capabilities that create measurable progress and help build bridges between health and other sectors of government.
- Plan to rapidly scale operations. Keeping up with the early growth of an epidemic is inherently difficult for those responding. COVID-19 cases grew exponentially in the early phase of the pandemic,14 but exponential scaling is very hard for human systems to match. Governments can improve their response to the next pandemic by predefining response plans so that scaling is a matter of activating existing protocols and resources. For example, procurement of supplies can move from standard to emergency protocols. Prepositioned stockpiles of personal-protective equipment can be tapped. And staff previously identified and trained to participate in response can be rapidly reassigned from their “peacetime” roles to join a coordinated response team.
- Prepare for effective response governance. In early 2020, COVID-19 escalated rapidly from infectious-disease-team management to a head-of-state issue. The Geneva Preparedness Forum15 participants described the importance of effective mechanisms to engage senior government leaders. Countries with processes that allowed for relevant technical expertise to be heard while escalating decisions to the appropriate level generally fared better during the pandemic. The best leader for peacetime public health activities is not always the right person to lead a public health crisis response; preidentifying incident leaders can help ensure smoother leadership and operations. The degree to which governance is centralized is another important question. Some response functions, such as R&D and evidence assessment, sit naturally at more central levels of government, while others, such as communication with citizens, are often better positioned at local levels. While there is no universal right answer on governance, predefining roles by level of government can help ensure a more seamless response.
As much as nations and jurisdictions may hope otherwise, COVID-19 will not be the last pandemic. But a wave of funding underscores the drive to be better prepared for the next public health crisis. Effectively measuring and tracking that preparedness may prove critical not only for guiding investments strategically but also for building greater confidence in readiness.